Care of Children and Young People with Cancer

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• Care of Children and Young People with Cancer
• Central Venous Catheters (CVCs)
• Recommendations for Future Practice

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Scotland
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Learning Outcomes

• Overview of the demographics/aetiology of
  children and young people with cancer within
  United Kingdom (UK)
• Consider the use of CVC/s in children and young
  people with cancer and the suitability of each
  CVC for each individual and the family

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Demographics

• 1,700 diagnosed in UK
• 150 diagnosed in Scotland40 between 16-18 years
  of age
• 2nd cause of death in childhood
• 76 survival rates
• Cancer is a key priority in UK
• Nursed within hospital and/or home setting
• Source
• CCLG 2009 Scottish Government 2008

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Childhood Cancer

• Children are not small adults
• Different from adult cancers
• Two most common occurring cancers are
• Leukaemia
• Brain and spinal tumours
• Since 1960s great advances in treatment
• 1977 UKCCSG began and centralisation of care
  evolved (CCLG 2009)

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Childhood Cancer

• The graph shows
• the of
• children diagnosed
• with each type of
• cancer per year in
• the UK
• National Statistics (2005)

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Aetiology

• There are many theories possible factors
• A vast amount of research
• Parents blame themselves/others
• Main possible factors
• Person
• (lifestyle, age, infection)
• Environmental
• (geographical distribution, radioactive
  materials, electricity pylons)
• Genetic Predisposition
• (inherited abnormal gene, mutation)

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Contributing Factors

• Improved experience of the cancer journey
• Paediatric oncology centres
• Multidisciplinary team
• Therapeutic advances national protocols
• Combination chemotherapy
• Radiotherapy
• Surgery
• Transplantation
• Supportive care

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Double-Lumen Portocatheter

• 4 year old child with a solid tumour
• Limited preparation for insertion CVC
• Child needle phobic
• Learning about the CVC through play

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A Scenario from Clinical Practice

• This child would scream, kick and shout, Please
  dont hurt me, no needles, no needles when she
  first arrived on the ward. The type of CVC this
  little girl has is a Double-LP.

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Hickman Catheter

• 13 year old young lad with Leukaemia
• Hickman (double-lumen initially inserted)
• Became infected
• Now has Hickman single-lumen

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Table 1 Summary of CVCs Table 1 Summary of CVCs Table 1 Summary of CVCs Table 1 Summary of CVCs
Type Advantages Disadvantages Comments
External Cathetheter/s (Broviac or Hickman) No gripper insertion Multiple access Easier to use in the home setting Can be repaired if damaged Less risk of extravasation Infection Accidental damage Blockage Altered body image If looked after well can stay in situ for the whole of the treatment. The internal diameter of the lumen must be taken into consideration and the size of the child. Small cloth bags (pouches) for the ends of the lines whilst not in use can keep them out of the way.
Implantable ports (Portocatheter Less maintenance No dressing for non-accessed port Device of choice for older child Swimming and bathing permitted when not accessed Less risk of infection Positive for Body Image Gripper insertion. Dislodgment needle incorrect placement, leads to extravasation. Catheter separation Blockage Bulky device for small underweight child Ports are more expensive but less costly to maintain Not suitable for children under 2 years The child family frequently are traumatized when the devices are being accessed Source(McInally 2005)
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Recommendations

• Preparation insertion of CVC/type
• Accessing
• Empowerment Child, young person and the Family

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Family Participation

• All family members to be involved
• Negotiation
• Support
• Education
• Source (Hollis et al 2008)

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• Any questions?
• Wendy McInally
• w.mcinally_at_napier.ac.uk
• 0131 455 5343

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References

• CCLG (2009) http//ukccsg.org/
• Hollis R, Denton S and Chapman G in Gibson F and
  Soanes L (2008) Cancer in Children and Young
  People, Acute Nursing Care London John Wiley
  Sons Ltd
• McInally W (2005) Whose Line is it Anyway?
  Paediatric Nursing17(5) 14-18
• National Statistics (2009) http//www.statistics.g
  ov.uk/CCI/nugget.asp?ID854Pos1ColRank2Rank2
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• Scottish Government 2008 http//www.scotland.gov.u
  k/Publications/2008/02/25093458/14